HomeMy WebLinkAboutChange of Contractor Planning&Development Services RECEIVE®
Building& Code Regulations Divisio 11
2300 Virginia Ave.
Fort Pierce,FL 34982 MAR 2 0 2018
(772)462-1553 Fax 462-1578
ST. Lucie County, Permitting
CHANGE OF CONTRACTOR
Or Subcontractor or Can ceUntion of Permit
.Change of Contractor is to be completed by the property owner,and the new contractor of record for the
current permit A new permit application must also be completed with new contractor information,,
signature, and transfer fee. A new Notice of Commencement must be filed in the new contractor?s
name for job values greater than $2,500 ($7,500 if A/C Change-ant). A recorded copy.must be
submitted prior to commencing any work. Subcontractor changes can be completed by the general
contractor. ,Absent extenuating circumstances, a cancellation of permit is to be executed by both the
owner and qualifier of record.
Date: .. ' Permit Number: �G
Site Address: Egg ce
'� /hS' D �7 p
lc t' State Licens 75' 7SLC License
Original Cran=l C nfrac:or(or subconwador)
!af'kt> u State License �c13� g�-SLC License
New (or Subcontiactor)
Reason for Channge
The undersigned does hereby agree to iundenmify and hold harmless St.Lucie County,its officers,
agents,and employees from all costs,fees,or damages arising from my and all claims of action for
any reason,which may arise as a result of this change of contractor/subcontractor or cancellation of
permit. A Pe 't cannot be cancelled if work has been perfgtlaioted. .
OF owNE1t (or ownerlbuilder) SIGNATUU OFf4ffiGEMAL CONTRA
! PRINT NAME i r7 1.�.TNAME r
State of Florida,County of St.Lucie County State of Florida,County of St Lucie County
The foilowi ng instrument was acknowledged before me this The following instrument was acknowledged before me this
day of "IT 20 by `" a day of�_.20 ,by e
who is ersomm",Qy lcrao o me �CQ+' a 1'n�who is porsonallylrnow to me
or ho has prod ed as 1D or ho has pmdu d re%! t8 S4s M.
1�
Signature of Not UT Date Signature erNotau Data
_ *Only signature required for change of subcontractor
Re �4.0 P Notary Publc state of Florida
Donna Lea Askman
�u►r�at,. Notary Public State of Flariga a My Commission GG 174054
{ Donna Lea A$kman a„ ' Expires o1/091 =
c: AQV Commission GG Jr
4064
oia ExpuesGt/Oel2u22
i
I
PERMITO � a, 53 ) ISSUE DATE
PLANNING& DEVELOPMENT SERVICES
Building & Code Compliance Division RECEIVED'!
• - BUILDING PERMIT MAR 2.0 2018
SLTig-CONTRACTOR AGREEMENT
ST. Lucie County, Permitting
have agreed to be
(Company NatneAndividual Name)
the �`CeJ Sub-contractor for �7 Z eAC(E, ak t 4 ' F01 4m*91
(Type of Trade) (Primary Contractor)
'For the project located at 70-4
(Project Street Address or Property Tax'ID
it is understood that,if 4wre is any change of status regarding our participation with the above mentioned
project,the Building and Code Regulation Division of St.Lucie County will be advised pursuant to the
filing of a Change of Sub-contractor notice.
C'rOlt SIGNATUItT(Qualifier)
ON7'C�iCTOIt SIGNATURE(Qualifier)
PRINT NAME M. FPUNT NAMi
COUNTY clRTMCATION NUMBER COUNTY CMTII+ICATION NUMBER
State at Florida,County of, •Ww{�' State of Norlde.Couaty of-6L211!:l C
sign•
The lbregatag instrutneat was ' ed before me this I day of The foregoing instmmentwas signed bobre me tltis day of
70.'by
who is personally knewo:or has produced a who Is personally known V,-'or has produced a
as Identification. as identI06tion.
STAMP SCAMP
gnatureofNo gPubti �ia re of Notary Public
-- -----
Lta
rlat Naate of Notary Public Print Name of Notary Pu lib'c
Notary Public Stata of Florida
a4 Donna Lea Askman
IC Commission GG 174054 Lau Berry
, I Expires 01/09/2022
NOTARY PUBLIC
a +STATi=OF FLORIDA
cw,o 00072511
Revised 11/16/2016
Expires 2113/2021